Provider Demographics
NPI:1073709341
Name:ROYA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ROYA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-673-8333
Mailing Address - Street 1:26 N BEACH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5663
Mailing Address - Country:US
Mailing Address - Phone:386-673-8333
Mailing Address - Fax:386-673-5236
Practice Address - Street 1:26 N BEACH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5663
Practice Address - Country:US
Practice Address - Phone:386-673-8333
Practice Address - Fax:386-673-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3695Medicare PIN